Please note: This post by the HIT Standards Committee’s Implementation Workgroup is now closed for comment. Monitor this blog for more posts from the FACA committees and its workgroups as issues develop. Also, please visit the Health IT Buzz Blog to join other Health IT related conversations.
Today, the Health IT Standards Committee within the Department of Health and Human Services will begin an unprecedented effort to get the public’s view on how our work might “pull forward” the benefits of healthcare information technology (IT). Specifically, we’re interested in uncovering new strategies to accelerate the adoption of health IT standards. This effort began with the passage of the American Recovery and Reinvestment Act of 2009, calling for recommendations on standards to promote safe, secure, healthcare information exchange.
“Standards” are really the guardians of quality, consistency, and interoperability. Without thoughtful, clear and uniform standards, we cannot enable the seamless and secure exchange of electronic health information (or the benefits that accrue to providers and patients from such protected exchanges).
So, while the exploration of technical standards may seem mundane to some, it is foundational to electronic health records (EHRs) and electronic health information exchange more broadly. In other words, it’s worth paying some attention to, and voicing your opinions.
Our process continues with a public hearing today in Washington, DC, accessible via phone and webcast at http://healthit.hhs.gov/portal/server.pt. We are convening four panels of experts with on-the-ground experience in interoperability standards – providers, quality stakeholders, health IT vendors, and a group with lessons drawn outside of healthcare. Thanks to HIT Standards Committee member Judy Murphy for her leadership on this effort.
The public hearing draws to a close this afternoon but we will continue the conversation through an Online Forum over the next two weeks. Thanks to Committee Member Cris Ross for his leadership on this effort. Given the breadth of interests, we have arranged a series of Committee Member blog posts to begin the dialogue, starting with HIT Standards Committee Vice-Chair John Halamka’s summary of our work to date, which will post on Friday. We will concurrently enable ongoing discussion threads on the following topics:
1) Proposed Standards (General Discussion)
2) Interoperability
3) Vocabularies
4) Privacy
5) Security
6) Quality
7) Implementation Case Studies (Your Story – the good, bad and in-between)
We have also enabled a “voting” feature on submissions to allow you – the public – an opportunity to emphasize points raised in a given post. Our goal is to harness the shared wisdom of our community to inform the work of the HIT Standards Committee in the weeks and months ahead.
The tight schedule of this process is designed to ensure that your ideas inform the HIT Standards Committee at its November 19th meeting. However, your ongoing feedback on our efforts is also encouraged via written submission or public comment at any of the subsequent monthly meetings of the HIT Standards Committee.
The process of accelerating the adoption of health IT standards will not end this week, this month, or this year. This is an ongoing effort, and your participation will continue to be essential to its success.
– Aneesh Chopra, U.S. Chief Technology Officer
Tags: FACA, Federal Advisory Committee Act, health IT, HIT Standards Committee
Our surgical group, Foris Surgical Group, LLP, currently has 4 physicians and had 5 physicians when we implemented a “hybrid” EMR–SRSSoftware’s product. Implementation was smooth and integration using an HL-7 interface with our practice management software (MISYS) works well. There is no loss in productivity when using this software so it allows the docs the opportunity to function efficiently–that is, it does not get in the way of patient care.
The template-driven systems that I’ve seen all try to force a history or physical exam into a “form”. It doesn’t make sense that a history–the narrative describing a patient’s symptoms should be anything but free text. There are many forms of information that we get (fax’s, lab tests, endoscopy reports, etc.) where having them inside of a “digital folder” makes them available to everyone in the office (and authorized users remotely) and gives us the ability to forward that information to others as needed.
I urge you to take a closer look at the hybrid EMR systems for certification.
Steven J. Brand, MD
Agree or Disagree:
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7 (+7)
No matter what EMR product (or hybrid) is being implemented, certain conditions must exist. Without these conditions in place, the EMR will never succeed and meaningful use never attained. The fundamental conditions for achieving meaningful use are:
1. Stable, reliable technical infrastructure with 100% uptime
2. Standards-based vocabularies AND data entry into discrete data fields (i.e. no text entry of critical information such as diagnoses, allergies, or medications)
3. Achievement of 80% utilization with an on-going plan to reach 100% within a reasonable time frame: (80% Rule=80% of providers use EMR all of the time AND/OR 80% of patient charts are 100% electronic)
4. Organizational leadership and change management support for technology-enabled process redesign
5. Data obtained from the EMR are directly used to improve provider performance and patient outcomes
These conditions are difficult to achieve, but without them there can be no success. Physicians need support at this basic level! Pie-in-the-sky proclamations about quality, consistency, and interoperability are far removed from the challenges of implementation at the level of the medical practice.
Finally, usability remains a huge challenge. Older applications are woefully inadequate compared with facile newer technology. It has been said that asking a physician to use an EMR can be like forcing them to write charts with their non-dominant hand. Would you submit happily to such a requirement?
Agree or Disagree:
11 
5 (+6)
The need for standards seems to be oriented towards a medical system where patients are moved around from doctor to doctor against their will, as in – socialized medicine.
When patients move themselves voluntarily, they can bring their records with them on paper, and a new practitioner can backload what they need into the new EHR.
The fictional scenario of showing up unconscious at some distant medical center, alone and without ID and contact information, and needing instant treatment that solely depends on an EHR (not on physician judgment) is so rare as to be nil.
In summary, there is no substantial benefit to patients of “standards”, only to payers and government regulators. It would be a lot cheaper to deliver paper records by FedEx than build a “national interoperable health IT system” at a cost of tens or hundreds of billions of dollars. Give that money to the poor so they can get care.
Elimination of the $$$ spent on all this would also allow hospitals to counterbalance medicare cuts and remain economically viable.
Hot debate. What do you think?
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12 (-3)
Hospital implemented EMR and CPOE has resulted in silent but deadly mistakes including mortality, morbidity and more than you can count, near misses. It is reported in the medical literature.
If this equipment (I will not name the vendor nor the hospital for retaliation has been administered for issuing complaints) was another type of device, eg knee joint or defibrillator, and caused such risk, it would undergo a Class 1 recall and be removed from the market place.
I suggest you check in with Senator Grassley for the list of complaints and go to the FDA database.
You will not get accurate reports by using this method. Do you think that doctors are going to post their unexpected deaths caused by this equipment in a public forum?
Agree or Disagree:
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6 (+5)
I do orthopedics in a large, multispeciality group. We have been on Excellian (a version of Epic) for three years. It adds 45-60 minutes per half day of clinic patients. As a specialist, I found little good for me in this system, but many frustrations and slow-downs. For my patients, the EMR is marginal (my help or hinder them), but for me the electronic record system is inefficient and hateful!
Agree or Disagree:
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5 (+7)
Several comments: There are over 2000 vendors of practice management software, and 1200+ EMR/EHR vendors. There is not consistency and agreement amongst the experts in the field. Also, we use a small, proprietary EMR very efficiently, but have no real hope of affording the process of CCHIT certification. Also, does making the physician the data entry worker (the slowest and lowest paying job in an office) make sense when by 2025, there will be 200,000+ shortage of health care providers? Just thinking on digital paper.
Agree or Disagree:
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5 (+9)
There is a lot to balance in deciding how to proceed with “meaningful use” definitions.
I wholeheartedly express my objection to there being one single certifying body that charges such high costs for certification that smaller companies with excellent software cannot afford to participate.
On a related note and as reported iin the Wall Street Journal, isn’t it curious that Senator Grassley has sent a letter to a number of the largest HIT software vendors whose products have been CCHIT ‘08 certified requesting information as a result of compalints about faulty software? It makes one wonder if certification is really the answer!
Agree or Disagree:
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5 (+5)
We have the largest private ophthalmology office in San Francisco and see upwards of 200 patients a day. We have been using the Hybred SRS system for several years and it is terrific. It does not slow us down, there is no “boiler plate modules”, it can be accessed from any office and at home, it is secure and most importantly it works! Over the years we have looked at other EMR’s but they all would significantly slow us down in seeing patients and are oriented towards primary care. The SRS system allows us to draw details of the patients exam which is very important in ophthalmology.
I encourage you to certify this excellent system for specialties that don’t fit the usual EMR mold..
A W Allen MD
Agree or Disagree:
12 
7 (+5)
I have had the “opportunity” to use three different EHR systems (all from implementation) at my last job.
All of them had huge gaps, especially as a specialist. I found that I needed an extra 5 hours per week to finish documentation. And on top of that, my productivity permanently dropped.
There were some benefits, but all on the retrieval side. On the data acquisition side, things were slowed dramatically. Also, patients were unhappy that I was spending more time on the computer than looking at them.
I’ve looked at all the major players and talked to dozens of practitioners. Only people who use hybrid systems seem happy.
Agree or Disagree:
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7 (+6)
Pine Medical Group, a 20+ provider multispecialty group in Fremont, MI has been using an EHR hybrid system (SRS) since August 2006. It was not, nor is it now CCHIT certified, and thus by the current criteria does not qualify for any stimulus incentives. However, it is second to none in function. It is not template driven, but does probably 95-99 % of functions that a traditional EHR does. The big difference from traditional EHR’s is that it works!
We went live on August 9, 2006. I blocked out 50% of my schedule for the next two months as I expected a major drop in productivity, after hearing all of the horror stories of my regional colleagues. On August 11, 2006, just two days later, I opened up my schedule fully and have never looked back. Our practice literally had no down time and absolutely no drop in production.
Function, ease of use, effective documentation, and reasonable cost of operation should be the primary focus and considered of utmost importance in any EHR.
It is my hope that as “meaningful use” continues to be developed, that we don’t shoot ourselves in the foot by ignoring some very basic areas, and a system such as ours, which works, should at least be seriously considered as meeting criteria.
Richard S Boss, MD
Agree or Disagree:
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8 (+4)